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So you had an ulcer that you thought had closed up, but every time you visit the podiatrist, he takes a scalpel to your foot and opens the ulcer back up. Why does he do that? Before I answer, let’s talk about three things that an ulcer needs to heal: Offloading, Blood Flow, and Decreased Bacterial Load.

Offloading means taking precautions to insure no weight is being put on the ulcer. This means altering shoe wear or even totally immobilizing the foot with the ulcer. If safety measures are not taken to avoid walking on the ulcer, the friction and sheer forces will not allow a diabetic’s delicate skin to heal over the ulcer.

Blood flow is the key to all healing. It contains the growth factors and oxygen needed for the skin to grow over and close the ulcer. In an effort to close the wound, the body will lay down fibrotic tissue. The wound then becomes “senescent” or asleep, meaning the body forgets that it’s there and stops sending blood and healing factors to it.

Bacteria is naturally found on our bodies, but it can’t penetrate intact skin. Once an ulcer opens up, bacteria can enter and produce substances that stop healing. Bacteria can even enter the blood stream and cause additional problems elsewhere.

Now, you were wondering why the podiatrist cuts you up when you come in. By removing the yellow, fibrotic tissue, we “wake up” the body, reminding it that a wound is there so it continues to send healing factors. We like to cut so that we see bleeding, pink tissue so that we know blood is reaching the wound. Bacteria like to grow on the fibrotic tissue, so by removing it, we decrease the bacteria load on the wound. And lastly, you are less likely to walk on a bleeding wound compared to a wound that looks healed over. By following these guidelines, the healing time of an ulcer is much faster.